Search results for: hospital waste management (HWM)

Authors: Michael Tupý, Vít Petránek

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The paper is focused on testing of the poly(vinyl butyral) (PVB) layer which had the function of a CO2 insulating protection against concrete and mortar carbonation. The barrier efficiency of PVB was verified by the measurement of diffusion characteristics. Two different types of PVB were tested; original extruded PVB sheet and PVB sheet made from PVB dispersion which was obtained from recycled windshields. The work deals with the testing CO2 diffusion when polymer sheets were exposed to a CO2 atmosphere (10% v/v CO2) with 0% RH. The excellent barrier capability against CO2 permeability of original and also recycled types of PVB layers was observed. This application of PVB waste can bring advantageous use in civil engineering and significant environmental contribution.

Keywords: windshield, poly(vinyl butyral), mortar, diffusion, carbonatation, polymer waste

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Authors: Mohamed Hendawy Mousa, Warda Youssef Mohamed Morsy

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Background: Sepsis is a major cause of mortality and morbidity in trauma patients. Body mass index as an indicator of nutritional status was reported as a predictor of injury pattern and complications among critically ill injured patients. Aim: The aim of this study is to investigate the relationship between body mass index and the development of sepsis, systemic inflammatory response syndrome among adult trauma patients at emergency hospital - Cairo University. Research design: Descriptive correlational research design was utilized in the current study. Research questions: Q1. What is the body mass index profile of adult trauma patients admitted to the emergency hospital at Cairo University over a period of 6 months?, Q2. What is the frequency of systemic inflammatory response syndrome and sepsis among adult trauma patients admitted to the emergency hospital at Cairo University over a period of 6 months?, and Q3. What is the relationship between the development of sepsis, systemic inflammatory response syndrome and body mass index among adult trauma patients admitted to the emergency hospital at Cairo University over a period of 6 months?. Sample: A purposive sample of 52 adult male and female trauma patients with revised trauma score 10 to 12. Setting: The Emergency Hospital affiliated to Cairo University. Tools: Four tools were utilized to collect data pertinent to the study: Socio demographic and medical data tool, Systemic inflammatory response syndrome assessment tool, Revised Trauma Score tool, and Sequential organ failure assessment tool. Results: The current study revealed that, (61.5 %) of the studied subjects had normal body mass index, (25 %) were overweight, and (13.5 %) were underweight. 84.6% of the studied subjects had systemic inflammatory response syndrome and 92.3% were suffering from mild sepsis. No significant statistical relationship was found between body mass index and occurrence of Systemic inflammatory response syndrome (2= 2.89 & P = 0.23). However, Sequential organ failure assessment scores were affected significantly by body mass index was found mean of initial and last Sequential organ failure assessment score for underweight, normal and obese where t= 7.24 at p = 0.000, t= 16.49 at p = 0.000 and t= 9.80 at p = 0.000 respectively. Conclusion: Underweight trauma patients showed significantly higher rate of developing sepsis as compared to patients with normal body weight and obese. Recommendations: based on finding of this study the following are recommended: replication of the study on a larger probability sample from different geographical locations in Egypt; Carrying out of further studies in order to assess the other risk factors influencing trauma outcome and incidence of its complications; Establishment of standardized guidelines for managing underweight traumatized patients with sepsis.

Keywords: body mass index, sepsis, systemic inflammatory response syndrome, adult trauma

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Authors: Adaour Mohamed Amine, Bachene Mohamed Sadek, Fortassi Mosaab, Siouda Wafaa

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Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea. The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73% and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic therapy, bone biopsy, diabetic foot

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Authors: Manjari Rai

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Urbanization is an inevitable process of development of human society and an outcome of economic development and scientific and technological progress. While urbanization process in promoting the development of human civilization, also no doubt, urban landscape has been a corresponding impact. Urban environment has suffered unprecedented damage majorly due to the increase in urban population density and heavy migration rate, traffic congestion, and environmental pollution. All this have however led to a major ecological degradation and imbalance. As lands are used for the rapid and unplanned urbanization, the green lands are diminished, and severe pollution is created by waste products. Plastic, the most alarming waste at landfill sites, is yet uncontrolled. Therefore, initiatives must be taken to reduce plastic mediated pollution and increase green application. However, increasing green land is not possible due to the landfill by urban structures. In order to create a harmonious environment, sustainable development in the urban landscape becomes a matter of prime focus. This paper thus discusses the concept of ecological design combined with the urban landscape design, green landscape design on urban structures and sustainable development through the use of recyclable waste materials which is also a low costing approach of urban landscape design.

Keywords: ecological, degradation sustainable, landscape, urban

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Authors: Kai-Chee Loh, Jingxin Zhang, Yen-Wah Tong

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Hydrolysis and acidogenesis are the rate-controlling steps in an anaerobic digestion (AD) process. Considering that the optimum conditions for each stage can be diverse diverse, the development of a multi-stage AD system is likely to the AD efficiency through individual optimization. In this research, we developed a highly integrate three-stage anaerobic digester (HM3) to combine the advantages of dry AD and wet AD for anaerobic co-digestion of food waste and horse manure. The digester design comprised mainly of three chambers - high-solids hydrolysis, high-solids acidogenesis and wet methanogensis. Through comparing the treatment performance with other two control digesters, HM3 presented 11.2 ~22.7% higher methane yield. The improved methane yield was mainly attributed to the functionalized partitioning in the integrated digester, which significantly accelerated the solubilization of solid organic matters and the formation of organic acids, as well as ammonia in the high-solids hydrolytic and acidogenic stage respectively. Additionally, HM3 also showed the highest volatile solids reduction rate among the three digesters. Real-time PCR and pyrosequencing analysis indicated that the abundance and biodiversity of microorganisms including bacteria and archaea in HM3 was much higher than that in the control reactors.

Keywords: anaerobic digestion, high-solids, food waste and horse manure, microbial community

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Authors: Hotlan Siagian, Han Tae Hee

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This study aims to examine the effect of supplier trust and top management involvement on the supply chain risk management through buyer-supplier relationship. The population of the research is 44 Korean companies domiciled in East and Central Java of Indonesia. The respondent consists of a top management level from each company. Data collection used a questionnaire designed with five-item Likert scale. Collected data were analyzed using structural equation modeling (SEM) technique with SmartPLS software version 3.0 to examine the hypotheses. The result revealed that supplier trust has an effect on supply chain risk management, top management involvement affects supply chain risk management, supplier trust influences buyer-supplier relationship, top management involvement affects the buyer-supplier relationship, and buyer-supplier relationship affects supply chain risk management. The last finding is that buyer-supplier relationship empirically mediates the effect of supplier trust and top management involvement.

Keywords: buyer supplier relationship, supplier trust, supply chain risk management, top management involvement

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Authors: Yuguang Gao, Mingtao Deng

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The integration of independently operating hospitals into a unified healthcare service system has become a strategic imperative in the pursuit of hospitals’ high-quality development. Central to the concept of group governance over such transformation, exemplified by a collaborative medical alliance, is the delineation of shared value, vision, and goals. Given the inherent disparity in capabilities among hospitals within the alliance, particularly in the treatment of different diseases characterized by Disease Related Groups (DRG) in terms of effectiveness, efficiency and resource utilization, this study aims to address the centralized decision-making of intra-hospital patient referral within the medical alliance to enhance the overall production and quality of service provided. We first introduce the notion of production utility, where a higher production utility for a hospital implies better performance in treating patients diagnosed with that specific DRG group of diseases. Then, a Discrete-Event Simulation (DES) framework is established for patient referral among hospitals, where patient flow modeling incorporates a queueing system with fixed capacities for each hospital. The simulation study begins with a two-member alliance. The pivotal strategy examined is a "whether-to-refer" decision triggered when the bed usage rate surpasses a predefined threshold for either hospital. Then, the decision encompasses referring patients to the other hospital based on DRG groups’ production utility differentials as well as bed availability. The objective is to maximize the total production utility of the alliance while minimizing patients’ average length of stay and turnover rate. Thus the parameter under scrutiny is the bed usage rate threshold, influencing the efficacy of the referral strategy. Extending the study to a three-member alliance, which could readily be generalized to multi-member alliances, we maintain the core setup while introducing an additional “which-to-refer" decision that involves referring patients with specific DRG groups to the member hospital according to their respective production utility rankings. The overarching goal remains consistent, for which the bed usage rate threshold is once again a focal point for analysis. For the two-member alliance scenario, our simulation results indicate that the optimal bed usage rate threshold hinges on the discrepancy in the number of beds between member hospitals, the distribution of DRG groups among incoming patients, and variations in production utilities across hospitals. Transitioning to the three-member alliance, we observe similar dependencies on these parameters. Additionally, it becomes evident that an imbalanced distribution of DRG diagnoses and further disparity in production utilities among member hospitals may lead to an increase in the turnover rate. In general, it was found that the intra-hospital referral mechanism enhances the overall production utility of the medical alliance compared to individual hospitals without partnership. Patients’ average length of stay is also reduced, showcasing the positive impact of the collaborative approach. However, the turnover rate exhibits variability based on parameter setups, particularly when patients are redirected within the alliance. In conclusion, the re-structuring of diagnostic disease groups within the medical alliance proves instrumental in improving overall healthcare service outcomes, providing a compelling rationale for the government's promotion of patient referrals within collaborative medical alliances.

Keywords: collaborative medical alliance, disease related group, patient referral, simulation

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Authors: Nabiha Bouafia, Asma Ben Cheikh, Asma Ammar, Olfa Ezzi, Mohamed Mahjoub, Khaoula Meddeb, Imed Chouchene, Hamadi Boussarsar, Mansour Njah

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Background: Hospital acquired infections (HAI) cause significant morbidity, mortality, length of stay and hospital costs, especially in the intensive care unit (ICU), because of the debilitated immune systems of their patients and exposure to invasive devices. The aims of this study were to determine the rate and the risk factors of HAI in an ICU of a university hospital in Tunisia. Materials/Methods: A prospective study was conducted in the 8-bed adult medical ICU of a University Hospital (Sousse Tunisia) during 14 months from September 15th, 2015 to November 15th, 2016. Patients admitted for more than 48h were included. Their surveillance was stopped after the discharge from ICU or death. HAIs were defined according to standard Centers for Disease Control and Prevention criteria. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: During the study, 192 patients had admitted for more than 48 hours. Their mean age was 59.3± 18.20 years and 57.1% were male. Acute respiratory failure was the main reason of admission (72%). The mean SAPS II score calculated at admission was 32.5 ± 14 (range: 6 - 78). The exposure to the mechanical ventilation (MV) and the central venous catheter were observed in 169 (88 %) and 144 (75 %) patients, respectively. Seventy-three patients (38.02%) developed 94 HAIs. The incidence density of HAIs was 41.53 per 1000 patient day. Mortality rate in patients with HAIs was 65.8 %( n= 48). Regarding the type of infection, Ventilator Associated Pneumoniae (VAP) and central venous catheter Associated Infections (CVC AI) were the most frequent with Incidence density: 14.88/1000 days of MV for VAP and 20.02/1000 CVC days for CVC AI. There were 5 Peripheral Venous Catheter Associated Infections, 2 urinary tract infections, and 21 other HAIs. Gram-negative bacteria were the most common germs identified in HAIs: Multidrug resistant Acinetobacter Baumanii (45%) and Klebsiella pneumoniae (10.96%) were the most frequently isolated. Univariate analysis showed that transfer from another hospital department (p= 0.001), intubation (p < 10-4), tracheostomy (p < 10-4), age (p=0.028), grade of acute respiratory failure (p=0.01), duration of sedation (p < 10-4), number of CVC (p < 10-4), length of mechanical ventilation (p < 10-4) and length of stay (p < 10-4), were associated to high risk of HAIS in ICU. Multivariate analysis reveals that independent risk factors for HAIs are: transfer from another hospital department: OR=13.44, IC 95% [3.9, 44.2], p < 10-4, duration of sedation: OR= 1.18, IC 95% [1.049, 1.325], p=0.006, high number of CVC: OR=2.78, IC 95% [1.73, 4.487], p < 10-4, and length of stay in ICU: OR= 1.14, IC 95% [1.066,1.22], p < 10-4. Conclusion: Prevention of nosocomial infections in ICUs is a priority of health care systems all around the world. Yet, their control requires an understanding of epidemiological data collected in these units.

Keywords: healthcare associated infections, incidence, intensive care unit, risk factors

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Authors: Evgeniya Ivanova

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Nowadays, in the literature, there is still no fixed definition of knowledge management that often remains only as an academic discipline. The current market situation is changing very quickly, the need of new technologies is high, and knowledge management is the area that ensures that the know-how has not been lost during market development and adoption. The study examines how knowledge management is being leveraged and practiced in the management consultancy companies and provides not only the tips and best practices of applied knowledge management approaches but also the validation matrix for its successful or unsuccessful implementation. Different knowledge management approaches are explored on the basis of their practical implementation, including related challenges, knowledge sharing process, and barriers that are typical for consulting firms mostly driven by the agile working culture. The relevance of proposed topic is confirmed by the finding that corporate working culture and the exponentially developing technologies have a direct impact on the success of practical implementation of knowledge management.

Keywords: knowledge management, knowledge management in practice, consulting firm, knowledge management success

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Authors: Rocio López, Miriam Tena, Montserrat Pérez, Rosario Solera

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Biotransformation of organic waste into biogas is considered an interesting alternative for the production of clean energy from renewable sources by reducing the volume and organic content of waste Anaerobic digestion is considered one of the most efficient technologies to transform waste into fertilizer and biogas in order to obtain electrical energy or biofuel within the concept of the circular economy. Currently, three types of anaerobic processes have been developed on a commercial scale: (1) single-stage process where sludge bioconversion is completed in a single chamber, (2) two-stage process where the acidogenic and methanogenic stages are separated into two chambers and, finally, (3) temperature-phase sequencing (TPAD) process that combines a thermophilic pretreatment unit prior to mesophilic anaerobic digestion. Two-stage processes can provide hydrogen and methane with easier control of the first and second stage conditions producing higher total energy recovery and substrate degradation than single-stage processes. On the other hand, co-digestion is the simultaneous anaerobic digestion of a mixture of two or more substrates. The technology is similar to anaerobic digestion but is a more attractive option as it produces increased methane yields due to the positive synergism of the mixtures in the digestion medium thus increasing the economic viability of biogas plants. The present study focuses on the energy recovery by anaerobic co-digestion of sewage sludge and waste from the aquaculture-fishing sector. The valorization is approached through the application of a temperature sequential phase process or TPAD technology (Temperature - Phased Anaerobic Digestion). Moreover, two-phase of microorganisms is considered. Thus, the selected process allows the development of a thermophilic acidogenic phase followed by a mesophilic methanogenic phase to obtain hydrogen (H₂) in the first stage and methane (CH₄) in the second stage. The combination of these technologies makes it possible to unify all the advantages of these anaerobic digestion processes individually. To achieve these objectives, a sequential study has been carried out in which the biochemical potential of hydrogen (BHP) is tested followed by a BMP test, which will allow checking the feasibility of the two-stage process. The best results obtained were high total and soluble COD yields (59.8% and 82.67%, respectively) as well as H₂ production rates of 12LH₂/kg SVadded and methane of 28.76 L CH₄/kg SVadded for TPAD.

Keywords: anaerobic co-digestion, TPAD, two-phase, BHP, BMP, sewage sludge, fish waste

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Authors: A. Wahid Uddin

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Obstetric anal sphincter injury carries significant morbidity for a woman and affects the quality of life to the extent of permanent damage to anal sphincter musculature. The study was undertaken in a district general hospital by retrospectively reviewing random 63 case notes of patients diagnosed with a significant third or fourth-degree perineal tear admitted between the year of 2015 to 2018. The observations were collected by a pre-designed questionnaire. All variables were expressed as percentages. The major risk factors noted were nulliparity (37%), instrumental delivery (25%), and birth weight of more than 4 kg (14%). Forceps delivery with or without episiotomy was the major contributing factor (75%). In the majority of the cases (71%), no record of any perineal protection measures undertaken. The study concluded that recommended perineal protection measures should be adopted as a routine practise.

Keywords: forceps, obstetrics, perineal, sphincter

Procedia PDF Downloads 117

Authors: Wenru Wang

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Over the past decades, Asia has emerged as the ‘diabetes epicentre’ in the world due to rapid economic development, urbanization and nutrition transition. There is an urgent need to develop more effective and cost-effective care management strategies in response to this rising diabetes epidemic. This study aims to develop and compare a nurse-led smartphone-based self-management programme with an existing nurse-led diabetes service on health-related outcomes among type 2 diabetes patients with poor glycemic control in Singapore. We proposed a randomized controlled trial with pre- and repeated post-tests control group design. A total of 128 type 2 diabetes patients with poor glycemic control will be recruited from the diabetes clinic of an acute public hospital in Singapore through convenience sampling. Study participants will be either randomly allocated to the experimental group or control group. Outcome measures used will include the 10-item General Self-Efficacy Scale, 11-item Revised Summary of Diabetes Self-care Activities, and 19-item Diabetes-Dependent Quality of Life. Data will be collected at 3-time points: baseline, three months and six months from the baseline, respectively. It is expected that this programme will be an alternative offered to diabetes patients to master their self-care management skills, in addition to the existing diabetes service provided in diabetes clinics in Singapore hospitals. Also, the self-supporting and less resource-intensive nature of this programme, through the use of smartphone app as a mode of intervention delivery, will greatly reduce nurses’ direct contact time with patients and allow more time to be allocated to those who require more attention. The study has been registered with clinicaltrials.gov. The trial registration number is NCT03088475.

Keywords: type 2 diabetes, poor glycaemic control, nurse-led, smartphone-based, self-management, health-relevant outcomes

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Authors: Anmar Dulaimi, Hassan Al Nageim, Felicite Ruddock, Linda Seton

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Fast-curing cold bituminous emulsion mixture (CBEM) including active filler from high calcium fly ash (HCFA) and waste material (LJMU-A2) has been developed in this study. This will overcome the difficulties related with the use of hot mix asphalt such as greenhouse gases emissions and problems in keeping the temperature when transporting long distance. The aim of this study is to employ petrographic examinations using scanning electron microscopy (SEM) for characterizing the hydrates microstructure, in a new binary blended cement filler (BBCF) system. The new BBCF has been used as a replacement to traditional mineral filler in cold bituminous emulsion mixtures (CBEMs), comprises supplementary cementitious materials containing high calcium fly ash (HCFA) and a waste material (LJMU-A2). SEM analysis demonstrated the formation of hydrates after varying curing ages within the BBCF. The accelerated activation of HCFA by LJMU-A2 within the BBCF was revealed and as a consequence early and later stiffness was developed in novel CBEM.

Keywords: cold bituminous emulsion mixtures, indirect tensile stiffness modulus, scanning electron microscopy (SEM), and high calcium fly ash

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Authors: Srinivasa Reddy Mallampati, Chi-Hyeon Lee, Nguyen Thanh Truc, Byeong-Kyu Lee

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Organic polymeric materials (plastics) are widely used in our daily life and various industrial fields. The separation of waste plastics is important for its feedstock and mechanical recycling. One of the major problems in incineration for thermal recycling or heat melting for material recycling is the polyvinyl chloride (PVC) contained in waste plastics. This is due to the production of hydrogen chloride, chlorine gas, dioxins, and furans originated from PVC. Therefore, the separation of PVC from waste plastics is necessary before recycling. The separation of heavy polymers (PVC 1.42, PMMA 1.12, PC 1.22 and PET 1.27 g/cm3 ) from light ones (PE and PP 0.99 g/cm3) can be achieved on the basis of their density. However it is difficult to separate PVC from other heavy polymers basis of density. There are no simple and inexpensive techniques to separate PVC from others. If hydrophobic the PVC surface is selectively changed into hydrophilic, where other polymers still have hydrophobic surface, flotation process can separate PVC from others. In the present study, the selective surface hydrophilization of polyvinyl chloride (PVC) by microwave treatment after alkaline/acid washing and with activated carbon was studied as the pre-treatment of its separation by the following froth flotation. In presence of activated carbon as absorbent, the microwave treatment could selectively increase the hydrophilicity of the PVC surface (i.e. PVC contact angle decreased about 19o) among other plastics mixture. At this stage, 100% PVC separation from other plastics could be achieved by the combination of the pre- microwave treatment with activated carbon and the following froth floatation. The hydrophilization of PVC by surface analysis would be due to the hydrophilic groups produced by microwave treatment with activated carbon. The effect of optimum condition and detailed mechanism onto separation efficiency in the froth floatation was also investigated.

Keywords: Hydrophilic, PVC, contact angle, additive, microwave, froth floatation, waste plastics

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Authors: Karin M. Granstrom

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Paper mills produce wastewater with a high content of organic substances. Treatment usually consists of sedimentation, biological treatment of activated sludge basins, and chemical precipitation. The resulting sludges are currently a waste problem, deposited in landfills or used as low-grade fuels for incineration. There is a growing awareness of the need for energy efficiency and environmentally sound management of sludge. A resource-efficient method would be to digest the wastewater sludges anaerobically to produce biogas, refine the biogas to biomethane for use in the transportation sector, and utilize the resulting digestate for soil improvement. The biomethane yield of pulp and paper wastewater sludge is comparable to that of straw or manure. As a bonus, the digestate has an improved dewaterability compared to the feedstock biosludge. Limitations of this process are predominantly a weak economic viability - necessitating both sufficiently large-scale paper production for the necessary large amounts of produced wastewater sludge, and the resolving of remaining questions on the certifiability of the digestate and thus its sales price. A way to improve the practical and economical feasibility of using paper mill wastewater for biomethane production and soil improvement is to co-digest it with other feedstocks. In this study, pulp and paper sludge were co-digested with (1) silage and manure, (2) municipal sewage sludge, (3) food waste, or (4) microalgae. Biomethane yield analysis was performed in 500 ml batch reactors, using an Automatic Methane Potential Test System at thermophilic temperature, with a 20 days test duration. The results show that (1) the harvesting season of grass silage and manure collection was an important factor for methane production, with spring feedstocks producing much more than autumn feedstock, and pulp mill sludge benefitting the most from co-digestion; (2) pulp and paper mill sludge is a suitable co-substrate to add when a high nitrogen content cause impaired biogas production due to ammonia inhibition; (3) the combination of food waste and paper sludge gave higher methane yield than either of the substrates digested separately; (4) pure microalgae gave the highest methane yield. In conclusion, although pulp and paper mills are an almost untapped resource for biomethane production, their wastewater is a suitable feedstock for such a process. Furthermore, through co-digestion, the pulp and paper mill wastewater and mill sludges can aid biogas production from more nutrient-rich waste streams from other industries. Such co-digestion also enhances the soil improvement properties of the residue digestate.

Keywords: anaerobic, biogas, biomethane, paper, sludge, soil

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Authors: Harminder Singh

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Cold spray is a novel and emerging technology for the fabrication of coating. In this study, coating is successfully developed by this process on superalloy surface. The selected coating composition is already proved as corrosion resistant. The microstructure of the newly developed coating is examined by various characterization techniques, for testing its suitability for high temperature corrosive conditions of waste incinerator. The energy producing waste incinerators are still running at low efficiency, mainly due to their chlorine based highly corrosive conditions. The characterization results show that the developed cold sprayed coating structure is suitable for its further testing in highly aggressive conditions.

Keywords: coating, cold spray, corrosion, microstructure

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Authors: Desmond Wade, Alfredo Ormazabal

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Background: Ever since it commenced its registration process of pre-hospital practitioners in the year 2000 through the Irish Government Statute Instrument (SI 109 of 2000) process, the approach to education of its professionals has changed drastically. The progression from the traditional behaviouristic to the current constructivist approach has been based on experiences from other sectors and industries, nationally and internationally. Today, the delivery of a safe and efficient ambulance service heavily depends on its practitioners’ range of technical skills, academic knowledge, and overall competences. As these increase, so does the level of complexity of paramedics’ everyday practice. This has made it inevitable to consider the 'Human Factor' as a source of potential risk and made formative institutions like the National Ambulance Service College to include it in their curriculum. Methods: This paper used a mixed-method approach, where both, an online questionnaire and a set of semi-structured interviews were the source of primary data. An analysis of this data was carried out using qualitative and quantitative data analysis. Conclusions: The evidence presented leads to the conclusion that in the National Ambulance Service there is a considerable lack of education of Human Factors and the levels in understanding of how to manage Human Factors in practice vary across its spectrum. Paramedic Practitioners in Ireland seem to understand that the responsibility of patient care lies on the team, rather than on the most hierarchically senior practitioner present in the scene.

Keywords: human factors, ergonomics, stress, decision making, pre-hospital care, paramedic, education

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Authors: S. M. C. Kelly, M. Goulden

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Introduction: Chronic Pancreatitis is an increasing problem worldwide. Pain is the main symptom and the main reason for hospital readmission following diagnosis, despite the use of strong analgesics including opioids. Ketamine infusions reduce pain in complex regional pain syndrome and other neuropathic pain conditions. Our centre has trialed the use of ketamine infusions in patients with chronic pancreatitis. We have evaluated this service to assess whether ketamine reduces emergency department admissions and analgesia requirements. Methods: This study collected retrospective data from 2010 in all patients who received a ketamine infusion for chronic pain secondary to a diagnosis of chronic pancreatitis. The day-case ketamine infusions were initiated in theatre by an anaesthetist, with standard monitoring and the assistance of an anaesthetic practitioner. A bolus dose of 0.5milligrams/kilogram was given in theatre. The infusion of 0.5 milligrams/kilogram per hour was then administered over a 6 hour period in the theatre recovery area. A study proforma detailed the medical history, analgesic use and admissions to hospital. Patients received a telephone follow up consultation. Results: Over the last eight years, a total of 30 patients have received intravenous ketamine infusions, with a total of 92 ketamine infusions being administered. 53% of the patients were male with the average age of 47. A total of 27 patients participated with the telephone consultation. A third of patients reported a reduction in hospital admissions with pain following the ketamine infusion. Analgesia requirements were reduced by an average of 48.3% (range 0-100%) for an average duration of 69.6 days (range 0-180 days.) Discussion: This service evaluation illustrates that ketamine infusions can reduce analgesic requirements and the number of hospital admissions in patients with chronic pancreatitis. In the light of increasing pressures on Emergency departments and the increasing evidence of the dangers of long-term opioid use, this is clearly a useful finding. We are now performing a prospective study to assess the long-term effectiveness of ketamine infusions in reducing analgesia requirements and improving patient’s quality of life.

Keywords: acute-on-chronic pain, intravenous analgesia infusion, ketamine, pancreatitis

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Authors: M. Tazky, R. Hela, P. Novosad, L. Osuska

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This paper deals with the possibility of safe incorporation fluidised bed combustion fly ash (waste material) into cement matrix together with next commonly used secondary raw material, which is high-temperature fly ash. Both of these materials have a very high pozzolanic ability, and the right combination could bring important improvements in both the physico-mechanical properties and the better durability of a cement composite. This paper tries to determine the correct methodology for designing green concrete by using modern methods measuring rheology of fresh concrete and following hydration processes. The use of fluidised bed combustion fly ash in cement composite production as an admixture is not currently common, but there are some real possibilities for its potential. The most striking negative aspect is its chemical composition which supports the development of new product formation, influencing the durability of the composite. Another disadvantage is the morphology of grains, which have a negative effect on consistency. This raises the question of how this waste can be used in concrete production to emphasize its positive properties and eliminate negatives. The focal point of the experiment carried out on cement pastes was particularly on the progress of hydration processes, aiming for the possible acceleration of pozzolanic reactions of both types of fly ash.

Keywords: high temperature fly ash, fluidized bed combustion fly ash, pozzolan, CaO (calcium oxide), rheology

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Authors: Inom Sh. Normatov, Nurmakhmad Shermatov, Rajabali Barotov, Rano Eshankulova

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The results of the studies for the hydrogen production by the application of water electrolysis and plasma-chemical processing of gas condensate-waste of natural gas production methods are presented. Thin coating covers the electrode surfaces in the process of water electrolysis. Therefore, water for electrolysis was first exposed to electrosedimentation. The threshold voltage is shifted to a lower value compared with the use of electrodes made of stainless steel. At electrolysis of electrosedimented water by use of electrodes from stainless steel, a significant amount of hydrogen is formed. Pyrolysis of gas condensates in the atmosphere of a nitrogen was followed by the formation of acetylene (3-7 vol.%), ethylene (4-8 vol.%), and pyrolysis carbon (10-15 wt.%).

Keywords: electrolyze, gascondensate, hydrogen, pyrolysis

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Authors: Biruhi Tesfaye, Avinash M. Potdar

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The laboratory test process to determine the California bearing ratio (CBR) of black cotton soils is not only overpriced but also time-consuming as well. Hence advanced prediction of CBR plays a significant role as it is applicable In pavement design. The prediction of CBR of treated soil was executed by Artificial Neural Networks (ANNs) which is a Computational tool based on the properties of the biological neural system. To observe CBR values, combined eggshell and waste glass was added to soil as 4, 8, 12, and 16 % of the weights of the soil samples. Accordingly, the laboratory related tests were conducted to get the required best model. The maximum CBR value found at 5.8 at 8 % of eggshell waste glass powder addition. The model was developed using CBR as an output layer variable. CBR was considered as a function of the joint effect of liquid limit, plastic limit, and plastic index, optimum moisture content and maximum dry density. The best model that has been found was ANN with 5, 6 and 1 neurons in the input, hidden and output layer correspondingly. The performance of selected ANN has been 0.99996, 4.44E-05, 0.00353 and 0.0067 which are correlation coefficient (R), mean square error (MSE), mean absolute error (MAE) and root mean square error (RMSE) respectively. The research presented or summarized above throws light on future scope on stabilization with waste glass combined with different percentages of eggshell that leads to the economical design of CBR acceptable to pavement sub-base or base, as desired.

Keywords: CBR, artificial neural network, liquid limit, plastic limit, maximum dry density, OMC

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Authors: Aneta Nitsch-Osuch, Katarzyna Zycinska, Ewa Gyrczuk, Agnieszka Topczewska-Cabanek, Kazimierz Wardyn

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Introduction: Influenza is an important clinical and epidemiological problem and should be considered as a possible nosocomial infection. The aim of the study was to determine the influenza vaccine coverage rates among Polish nurses and to find out drivers and barriers for influenza vaccination among this group of health care workers (HCWs). Material and methods: The self- fulfilled survey with 26 questions about the knowledge, perception, and influenza coverage rates was distributed among 461 nurses. Results: Only 15% of nurses were vaccinated against influenza in the consecutive seasons. The majority (75%) of the regularly vaccinated nurses were ambulatory careworkers. The difference between the number of vaccinated hospitals and ambulatory care nurses was statistically significant (p < 0.05). The main motivating factors for an influenza vaccination were: a fear of the illness and its complications (97%) and a free of charge vaccine available at the workplace (87%). Ambulatory care nurses more often declared that they were vaccinated mainly to protect themselves while hospital care nurses more often declared the will to protect their patients, these differences in the perception and attitudes to an influenza vaccination among hospital and ambulatory care nurses were statistically significant (p < 0.05). The main barriers for an influenza vaccination among the nursing staff were: a lack of reimbursement of the vaccine (95%), a lack of insufficient knowledge about the effectiveness, and safety of the influenza vaccine (54%). The ambulatory care nurses more often found influenza vaccination as the ethical duty compared to hospital care nurses (p < 0.05). Conclusions: The influenza vaccine coverage rates among the Polish nurses are low and must be improved in the future. More educational activities dedicated to HCWs may result in the increased awareness of influenza vaccination benefits for both medical professionals and patients.

Keywords: influenza, vaccination, nurses, ambulatory careworkers

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Authors: Randy Molejona Jr., Elaine Nicole Saquin

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The area around the Ajuy river in Iloilo, Philippines, is currently being mined for manganese ore, and river water samples exceed the maximum manganese contaminant level set by US-EPA. At the same time, the surplus of local bivalve waste is another environmental concern. Synthetic chemical treatment compromises water quality, leaving toxic residues. Therefore, an alternative treatment process is biosorption or using the physical and chemical properties of biomass to adsorb heavy metals in contaminated water. The study aims to extract crude chitin from shell wastes of Bractechlamys vexillum, Perna viridis, and Placuna placenta and determine its adsorption capacity on manganese in simulated and actual mine water. Crude chitin was obtained by pulverization, deproteinization, demineralization, and decolorization of shells. Biosorption by flocculation followed 5 g: 50 mL chitin-to-water ratio. Filtrates were analyzed using MP-AES after 24 hours. In both actual and simulated mine water, respectively, B. vexillum yielded the highest adsorption percentage of 91.43% and 99.58%, comparable to P. placenta of 91.43% and 99.37%, while significantly different to P. viridis of -57.14% and 31.53%, (p < 0.05). FT-IR validated the presence of chitin in shells based on carbonyl-containing functional groups at peaks 1530-1560 cm⁻¹ and 1660-1680 cm⁻¹. SEM micrographs showed the amorphous and non-homogenous structure of chitin. Thus, crude chitin from B. vexillum and P. placenta can be bio-sorbents for water treatment of manganese-impacted effluents, and promote appropriate waste management of local bivalves.

Keywords: biosorption, chitin, FT-IR, mine effluents, SEM

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Authors: Osama Zayed

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Aim of the work: The aim of this study is to assess the predictors of pelvic vascular injuries in patients with pelvic fractures from major blunt trauma. Methods: This study was conducted as a tool-assessment study. Forty six patients with pelvic fractures from major blunt trauma will be recruited to the study arriving to department of emergency, Suez Canal University Hospital. Data were collected from questionnaire including; personal data of the studied patients and full medical history, clinical examinations, outcome measures (The Physiological and Operative Severity Score for enumeration of Mortality and morbidity (POSSUM), laboratory and imaging studies. Patients underwent surgical interventions or further investigations based on the conventional standards for interventions. All patients were followed up during conservative, operative and post-operative periods in the hospital for interpretation the predictive scores of vascular injuries. Results: Significant predictors of vascular injuries according to computed tomography (CT) scan include age, male gender, lower Glasgow coma (GCS) scores, occurrence of hypotension, mortality rate, higher physical POSSUM scores, presence of ultrasound collection, type of management, higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) POSSUM scores, presence of abdominal injuries, and poor outcome. Conclusions: There was higher frequency of males than females in the studied patients. There were high probability of morbidity and low probability of mortality among patients. Our study demonstrates that POSSUM score can be used as a predictor of vascular injury in pelvis fracture patients.

Keywords: predictors, pelvic vascular injuries, pelvic fractures, major blunt trauma, POSSUM

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Authors: Kulwinder Singh Mann

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The innovative features of information system, known as Radiology Information System (RIS), for electronic medical records has shown a good impact in the hospital. The objective is to help and make their work easier; such as for a physician to access the patient’s data and for a patient to check their bill transparently. The interoperability of RIS with the other intra-hospital information systems it interacts with, dealing with the compatibility and open architecture issues, are accomplished by two novel mechanisms. The first one is the particular message handling system that is applied for the exchange of information, according to the Health Level Seven (HL7) protocol’s specifications and serves the transfer of medical and administrative data among the RIS applications and data store unit. The second one implements the translation of information between the formats that HL7 and Digital Imaging and Communication in Medicine (DICOM) protocols specify, providing the communication between RIS and Picture and Archive Communication System (PACS) which is used for the increasing incorporation of modern medical imaging equipment.

Keywords: RIS, PACS, HIS, HL7, DICOM, messaging service, interoperability, digital images

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Authors: Asif Iqbal

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Working capital management has its effect on liquidity as well as on profitability of a firm. In this research we have selected a sample of 100 respondents whose firms are listed on Karachi stock exchange. We have studied the effect of different variable s of working capital management. We find that organizations throughout the world as well as in Pakistan have to give immense recognition to the working capital management as it is an effective thing from their long term perspective especially to their shareholders to have a firm confidence over the companies for investment purpose.

Keywords: working capital management, Karachi stock exchange, shareholders, capital management

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Authors: Ryan Masoodi, Hossein Rostami

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Aluminum has been credited for the massive advancement of many industrial products, from aerospace and automotive to electronics and even household appliances. These developments have come with a cost, which is a toxic by-product. The rise of aluminum production has been accompanied by the rise of a waste material called Bauxite Residue or Red Mud. This toxic material has been proved to be harmful to the environment, yet, there is no proper way to dispose or recycle it. Herewith, a new experimental method to utilize this waste in the building material is proposed. A method to mix red mud, fly ash, and some other ingredients is explored to create a new construction material that can satisfy the minimum required strength for bricks. It concludes that it is possible to produce bricks with enough strength that is suitable for constriction in environments with low to moderate weather conditions.

Keywords: bauxite residue, brick, red mud, recycling

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Authors: Jaffry Zakaria, Nor Azlina Hasbullah

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The research on water quality based on 'Water Quality Index' (WQI) has been on the run along Kampar River in Perak State of Malaysia. This study was conducted to achieve several key objective that determe the value of the parameters that were studied based on Water Quality Index (WQI). The parameters include Dissolved Oxygen (DO), pH, Biochemical Oxygen Demand (BOD), Chemical Oxygen Demand (COD) and Suspended Solids. In this study, three sampling stations were selected. Through observations from the researchers, several pollutions were found occurring along the research area such as the disposal of waste water directly without treatment from villagers, widespread dumping of solid waste and the development of the surrounding areas that contributed to the pollution of Sungai Kampar in Perak, Malaysia. Sungai Kampar is commonly used for water recreational activities as well as for bathing purposes. Results showed that Sungai Kampar is classified under category III. According to Interim National Water Quality Standard for Malaysia (INWQS), rivers in the third grade are clean but not suitable for river recreational activities. Therefore, there is a requirement to investigate and analysis the water quality of all white water rivers in Malaysia focusing on the area of water activities. The combination of technology and risk management based on risk assessments can help the recreational industry to survive in future.

Keywords: risk assessments, White Water River, water quality index (WQI), Interim National Water Quality Standard for Malaysia (INWQS)

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Authors: Taufik Hidayat, Yudha Nurhantari, Bambang U. D. Rianto

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Introduction: The examination of the Short Tandem Repeats (STR) locus on nuclear DNA is very useful in solving the paternity cases. The purpose of this study is to know the description of paternity cases and paternity index/probability of paternity analysis based on Indonesian allele frequency at Sardjito Hospital Yogyakarta. Method: This was an observational study with cross-sectional analytic method. Population and sample were all cases of disputed paternity from January 2011 to June 2015 that fulfill the inclusion and exclusion criteria and were examined at Forensic Medicine Unit of Sardjito Hospital, Medical Faculty of Gadjah Mada University. The paternity index was calculated with EasyDNA Program by Fung (2013). Analysis of the study was conducted by comparing the results through unpaired categorical test using Kolmogorov-Smirnov test. This study was designed with 95% confidence interval (CI) with α = 5% and significance level is p < 0,05. Results: From 42 disputed paternity cases we obtained trio paternity cases were 32 cases (76.2%) and duo without a mother was 10 cases (23.8%). The majority of the fathers' estimated ages were 21-30 years (33.3%) and the mother's age was 31-40 years (38.1%). The majority of the ages of children examined for paternity were under 12 months (47.6%). The majority of ethnic clients are Javanese. Conclusion of inclusion was 57.1%, and exclusion was 42.9%. The Kolmogorov-Smirnov test obtained p-value = 0.673. Conclusion: There is no significant difference between paternity index/probability of paternity based on Indonesian allele frequency between trio and duo of paternity.

Keywords: disputed paternity, paternity index, probability of paternity, short tandem

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Authors: Sara Khan Mohammadi

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The world is facing a major challenge of feeding a growing population while ensuring the sustainability of food systems. The United Nations estimates that the global population will reach 9.7 billion by 2050, which means that food production needs to increase by 70% to meet the demand. However, this increase in food production should not come at the cost of environmental degradation, loss of biodiversity, and climate change. Therefore, there is a need for sustainable food systems that can provide healthy and nutritious food while minimizing their impact on the environment. Nutrition and Food Engineering: Nutrition and food engineering play a crucial role in promoting sustainable food system. Nutrition is concerned with the study of nutrients in foods, their absorption, metabolism, and their effects on health. Food engineering involves the application of engineering principles to design, develop, and optimize food processing operations. Together, nutrition and food engineering can help to create sustainable food systems by: 1. Developing Nutritious Foods: Nutritionists and food engineers can work together to develop foods that are rich in nutrients such as vitamins, minerals, fiber, and protein. These foods can be designed to meet the nutritional needs of different populations while minimizing waste. 2. Reducing Food Waste: Food waste is a major problem globally as it contributes to greenhouse gas emissions and wastes resources such as water and land. Nutritionists and food engineers can work together to develop technologies that reduce waste during processing, storage, transportation, and consumption. 3. Improving Food Safety: Unsafe foods can cause illnesses such as diarrhea, cholera, typhoid fever among others which are major public health concerns globally. Nutritionists and food engineers can work together to develop technologies that improve the safety of foods from farm to fork. 4. Enhancing Sustainability: Sustainable agriculture practices such as conservation agriculture can help reduce soil erosion while improving soil fertility. Nutritionists and food engineers can work together to develop technologies that promote sustainable agriculture practices.

Keywords: sustainable food, developing food, reducing food waste, food safety

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